AB0643 THE ANALYSIS OF RISK FACTORS FOR PRETERM BIRTH AND LOW BIRTH WEIGHT IN SLE PATIENTS WITH OR WITHOUT ATTAINED LLDAS AT THE CONCEPTION
Authors: H. Shimada, R. Wakiya, S. Nakashima, T. Miyagi, Y. Ushio, K. Sugihara, R. Mino, M. Mizusaki, K. Chujo, T. Kameda, H. Dobashi
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Women with systemic lupus erythematosus (SLE) have a higher risk for adverse pregnancy outcomes (APOs) including preterm birth (PB) and low birth weight (LBW) [1]. These APOs are revealed to be related to uncontrolled higher disease activity during pregnancy [2]. Currently, lupus low disease activity state (LLDAS), which is a comprehensive disease activity index, is suggested to be the treatment target to control damage accumulation. However, it is controversial whether achieving LLDAS during pregnancy can be a sufficient therapeutic target to prevent APOs. <h3>Objectives</h3> We analyze the risk factors for PB and LBW in SLE patients with or without achieving LLDAS at conception. <h3>Methods</h3> We used the data of SLE patients who have been treated at the planning for pregnancy from a single center cohort. We divided into LLDAS achieved group and LLDAS non-achieved group, and evaluated the rate of pregnancy outcomes, especially in preterm birth and low birth weight. We also analyzed the risk factors for PB and LBW from therapeutic agents (glucocorticoid use and their doses), and serum immunological parameters (C3, C4, CH50 levels and the titer of anti-dsDNA antibody). <h3>Results</h3> In 66 pregnancies complicated with SLE, 42 cases (63.6%) achieved LLDAS at conception, while the other 24 cases (36.4%) did not. Table 1 showed the risk factors for PB and LBW by analyzed separately for LLDAS attained group and not-achieved LLDAS group. As for PB, mean glucocorticoid dose became a risk factor in both LLDAS attained group and not-attained LLDAS group (P=0.02 and 0.01). In addition, only for the group that did not achieve LLDAS, serum C3 levels were associated with the rate of PB. On the other hand, in the group achieving LLDAS, glucocorticoid use, mean glucocorticoid dose, and serum CH50 levels were identified as risk factors for LBW in addition to serum C3 levels (P=0.04, &lt;0.01, 0.02, and 0.045). None of these factors were associated with LBW in the SLE patients without LLDAS achievement. <h3>Conclusion</h3> We revealed that glucocorticoid dose during pregnancy was found to be a risk factor for PB, regardless of whether or not the LLDAS was achieved at conception. As for LBW, low levels of C3 and CH50 was shown to be a risk factor even if LLDAS could be achieved at conception. Therefore, it is important to control the immunological disease activity parameters strictly for improving pregnancy outcomes, even if LLDAS, a comprehensive disease activity index, is achieved at conception. <h3>References</h3> [1]Bundhun PK, Soogund MZ, Huang F. Impact of systemic lupus erythematosus on maternal and fetal outcomes following pregnancy: a meta-analysis of studies published between years 2001–2016. J Autoimmun. 2017;79:17-27. [2]Clowse ME, Magder LS, Petri M. The clinical utility of measuring complement and anti-dsDNA antibodies during pregnancy in patients with systemic lupus erythematosus. J Rheumatol. 2011;38:1012-6. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.